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Values-attributes needed to make Decisions in Health, from the Essential Functions of Public Health

Hernández Medina Miriam Selene, Hernández Serrano Carolina, López González Ana Laura, Barragán López Norma, Islas Vega Iracema, Mariela Lizbeth Cobián Díaz, Reynoso Vázquez Josefina, Ruvalcaba Ledezma Jesús Carlos*

Academic Area of Medicine and Masters in Public Health [ICSa-UAEH]

Abstract: It is understood as public health functions the set of actions that must be carried out with specific purposes, necessary for the achievement to improve the health of populations. The objective was in Analyze the values-attributes, honesty, knowledge, passion and social sensitivity from the execution of the essential functions of public health in our country "Mexico" decreed by PAHO in 1997. A systematic review of articles detected on the internet and a video titled [Medellin, From Fear to Hope] with the central theme Medellin Colombia the most educated, articles and critical analysis of our reality on the matter. It was found that in our country there are many areas of opportunity to carry out the essential functions of public health, corruption, non-knowledge-based employment or curriculum of health professionals, lack of passion for what they do linked with the lack of knowledge and therefore the lack of social sensitivity. In conclusion. The quality of the work based on values, honesty, knowledge, passion and social sensitivity is deficient derived from antivalores-corruption, so in addition, the execution of the essential functions of public health in our country is limited, for the same quality of poor health care.

Keywords: values, government decisions, corruption, anti-values, essential functions of public health, quality of health care

Citation: Hernández Medina Miriam Selene, Hernández Serrano Carolina, López González Ana Laura, Barragán López Norma, Islas Vega Iracema, Mariela Lizbeth Cobián Díaz, Reynoso Vázquez Josefina, Ruvalcaba Ledezma Jesús Carlos, Values-attributes needed to make Decisions in Health, from the Essential Functions of Public Health. American Journal of Public Health Research, 5 (5). 154-158. January 2017. doi:10.12691/ajphr-5-5-3

1. Introduction

Public health is a functional and operative science within the health system in which functions can be identified to characterize it operationally and optimize its performance, it has established objectives and to achieve them the 11 essential functions of public health were designed by the Pan American Organization of health in 1997, it is understood as functions of public health to the set of actions that must be carried out with specific purposes, necessary to obtain the central objective: to improve the health of the populations [1,14].

The operability of a function depends, first of all, on a sufficient definition of its contents, objectives and activities and also on the specific allocation of who is responsible for its execution [1,14]. That is, one of the necessary values of those who make the decisions; According to Fajardo, S. [2], decision makers must have values such as honesty, knowledge, passion and social sensitivity, in our country the people who make the most important decisions of society are the politicians, including health decisions, however, it is because of the lack of these values that the country is reflected in a situation of discontent and social inequality in an alarming way; we will establish as a point of reference the essential functions of public health, aspects that refer to the public good and the actions and strategies to be implemented to strengthen public health, to give a look at the problem that we face day by day and the lack of values in the people in charge of making the decisions.

2. Critical Analysis

The first essential function of public health refers to the monitoring and analysis of the health situation of the population. Among the aspects that make reference to the public good of this function was found: - Have a statistical system, with access at different levels of the health system, government and society to monitor changes in the health of the population and make decisions based on evidence.

- Have information to evaluate the actions of public health and health system and alert about adverse trends.

- Have a system to detect, monitor and evaluate public health emergencies.

-Access to information, accountability that can objectively assess the performance of the health sector ([3] cited by [1]).

In our country, there are epidemiological surveillance systems in the different health services, however, it is not possible to comply with the first essential function of public health because the information that is collected is not available to the entire population, it is reserved according to the interests of those in power, politicians, denounces a lack of honesty, lack of social sensitivity, maybe there is knowledge but as long as health management policies are not changed, compliance cannot be achieved, as the current maladjustment remains the corruption. In addition, because of this situation, there is an air of distrust in the data that is decided to share, because to relive experiences such as the outbreak of cholera in hidalgo some years ago it is clear that it is not a priority of the government to communicate effectively the adverse trends in public health or report accounts. Regarding the second essential function of public health, which is the Public Health Surveillance, research and control of risks and damages in public health, it was detected that:

- Have an early warning system that allows the detection and timely control of outbreaks and emerging diseases to safeguard the health status of the population and the quality of life and contribute to global security by reporting events of international relevance.

-Decisions based on the best possible evidence ([3] cited by [1]).

Unfortunately, by not inserting properly trained personnel in the corresponding job positions, it has generated that the actions of this function are not carried out as they should, the lack of knowledge, honesty, passion and social sensitivity of the personnel who are developing a job that they do not know, because they were only placed there by friendships or “compadrazgos”, obstructs this type of actions which results in many situations getting out of control, lack of timely responses, lack of surveillance actions, etc. Such a situation occurs in those communities located along contaminated rivers, such as the situation of the Santiago River in Juanacatlán, Jalisco, the population lives sick because of the contaminants present in the river derived from the installation of industrial corridors that without regulation of the discharge of their waste contaminating the river and damaging the health of the community, here the control of risks and damages to the public health shines by its absence due all to the corruption of the government and its lack of values.

Regarding the aspects of the public good of the third essential function of public health, Health Promotion, we find:

-Have public policies and programs to strengthen the skills of citizens and communities to increase their health and favor their environment.

-Generation of healthy policies, strengthening community and social participation and the development of skills so that people and communities can influence health determinants and improve it ([3]. cited by [1]).

In Mexico there has been a traditional, paternalistic education system in which the patient or the community is seen as being incapable of developing skills and abilities that allow the self-care of their health, instead has chosen to treat them as children, giving them orders and telling them what to do without explaining the reasons, acting passively, not including them, inactivating them completely, this with the clear intention that the people remain in a state of blindness, without restlessness and without complaint, is the lack of education the worst enemy of our society, for lack of the values of the people who make the decisions in our country, the politicians. Strategies have been generated to combat public health problems in Mexico, such as obesity and diabetes. However, they fail to implement them because of the lack of an educational model that activates and empowers participants to generate skills so that they themselves build their own knowledge and take it to practice making their learning meaningful, as long as they do not have trained personnel and educate the population from a constructivist approach the management of public health policies cannot be carried out and promotion to health will be incomplete.

Regarding the fourth essential public health functions, Social participation and empowerment of citizens in health:

-Contain mechanisms to ensure the participation of communities in health policies and decisions ([3] cited by [1]). As mentioned earlier this lack of inclusion in the decisions of their own health, the lack of knowledge construction, makes the participation of citizenship is scarce, this represents one of the major barriers in community participation in prevention programs, diagnosis, treatment and rehabilitation. In order for health policies to be carried out effectively, it is necessary for decision-makers to have a social sensitivity, which leads to co-responsibility, that is, the mutual commitment of the authorities and the community for a common good, the building alliances to promote healthy environments and adequate education. As in the case of schools, childhood obesity is a priority public health issue in Mexico, the lack of a healthy environment for children due to weak regulatory policies for junk food is generating alarming figures in the country, making us deserving of the 1st place in the world, due all to corruption again, to the lack of values and co-responsibility, which undoubtedly influence the spread of this epidemic.

Refering to the fifth essential public health functions, which has the title Development of policies, plans and management capacity, has as public good:

- Have healthy public policies that translate into norms and programs to develop healthy lifestyles, choices of healthier options promoting the conditions of universal accessibility to them. ([3] cited by [1]). In relation to this function and as mentioned by Ruelas-Barajas and Gay-Molina [4], the formulation of laws, public policies and regulations must make it effective to promote and protect citizens' rights, in order to ensure that they reach the desired impact, since if this is not achieved, there are often gaps that end up rendering them inoperable, in this statement we see what normally happens in Mexico, since the lack of knowledge and social sensitivity by those who have the decision-making function is deficient , generating such immense gaps between the policy or plan generated by the state and the population, this due to several factors, one of them, the lack of research of the specific populations to whom they are directed so that they have a satisfactory result has to adapt the plan generated to the target population, giving this relationship a greater chance of success. An example of this is the National Development Plan (2013 - 2018), which refers to a large number of objectives and strategies that if applied with honesty and commitment in society, Mexico would not have the shortcomings in all fields: education, health, social and others.

The sixth essential function of public health, Regulation and Control in Public Health, which indicates as a public good:

- Have a legislative framework and standardization and regulation to promote public health actions and programs and generate healthy environments.

- Execution of regulatory activities in a timely, correct, consistent and complete manner. ([3] cited by [1]). In Mexico, through the history of public health, several macro and micro strategies have been generated, which include the "structural change of health", which resulted in a legislative renewal in health, reflected in the general law health and state health laws [4]. The general health law (s.f), article 1 states that "This Law regulates the right to health protection that everyone has in the terms of Article 4. of the Political Constitution of the United States of Mexico establishes the bases and modalities for access to health services and the concurrence of the Federation and the federal entities in matters of general health. It is applicable throughout the Republic and its provisions are of public order and social interest "; within this law and in all articles, chapters and sections that make it up, it is observed that in theory, it is a quite complete legislation, covering each of the health aspects that require attention in the Mexican population, however in daily practice, most of these guidelines marked in law, which are established in this document, should be mandatory, are simply not met or respected by health services. Which differs from the value of knowledge of the same laws by those who carry out the provision of medical care for the population, as well as a lack of social sensitivity, to support vulnerable groups.

The seventh essential public health function is entitled: Evaluation and promotion of equitable access to services, mentions as a public good:

- Favor the equity in the distribution of health among the population.

- Promotion of equity in access to health care, access to services, evaluation and promotion of access to health services, collaboration with non-governmental organizations (NGOs), to promote health in vulnerable groups. ([3] cited by Ruvalcaba Ledezma, J. C., et al, [1]).

From its beginnings the Mexican health system has been a fragmented, unequal system characterized by inequity, inaccessibility and inability to respond to health conditions in terms of coverage and quality of services [7], according to the aforementioned and even in the present, in Mexico a very low quality is observed provided by the health services managed by the government, which are exalted saying that they are inclusive with the general population, when in reality it is observed that only those who pay for receiving them are accepted, and even sometimes it does not go away like this, because even those whom the government charges for these services are not treated with quality and warmth, in breach of the value of the social sensitivity, in addition to this the scarce resources in which they are often found, being unable to provide the attention.

Regarding the eighth essential public health function which has as its title: Development of human resources and training in public health, has as public good:

- Have a trained workforce with competencies to develop the primary functions of public health.

- Education, training and evaluation of public health personnel, adherence to programs for continuous improvement, quality of services.

- Definition of requirements for the bachelor's degree in health professionals.

- Capacity building for interdisciplinary work in public health. ([3] cited by [1]).

As mentioned by Ruelas-Barajas and Molina (2008), because in our country health professionals and decision-makers have very limited training in efficiently seeking relevant and objective information for translation and public policy implementation, there are no solid bases for their support. In addition to this, high quality information and objectivity is not readily available. Because of this the evidence provided by research has been scarcely used in the processes of building public protection policies [5]

This is of the utmost importance since it indicates that the training of health personnel responsible for the generation, evaluation and implementation of public policies focused on population well-being must be the correct one, since this will reflect the quality of care to the population applying new strategies of education for promotion to health, prevention and treatment as it is educating with a socio-constructivist approach that functions as a learning trigger and generator of healthy behaviors [6]; in addition, interacting with professionals from other specific areas of health enriches the implementation of programs or plans in the population, more if all these professionals are prepared in Public Health, which unifies the ideals and objectives that arise when working. However in our country this training is still inefficient for professionals who are inclined to Public Health, since it requires that knowledge and implementation of new teaching approaches for them and of them for the population in terms of health promotion, including in this way the value of the passion for the work that they exert when being a member of the public health professionals community that exerts actions for the improvement of the quality of life in the population.

The ninth essential function of public health refers to the Quality Assurance of individual and collective health services:

-Have a health system that guarantees quality, warmth, efficiency in the provision of services.

-Promotion of permanent systems of quality assurance and monitoring.

-In summary; Use of this system to evaluate the quality of the direct provision of health services ([3] cited by [1]).

The quality of services in Mexico as a country that is required to ensure a life of bio-psycho-social health depends a lot on how it manages to have a health system that not only has the first thing but also has the necessary warmth in providing the adequate health services for each type of population that needs to be approached. The secretary of health in her book "The quality of health care in Mexico through its institutions: 12 years of experience", gives us an approach to what in that period has tried to achieve with the national crusade, quality of medical care, patient safety among others [8]. Unfortunately, despite these measures, it has not yet been possible to eradicate many actions that health services sometimes know but do not implement, because knowledge is not constructivist and can begin with the elimination of barriers in the health sectors. Forbes magazine in Mexico published the information that in our country the distribution of money for health is totally disorganized, the average Mexican pays an insane amount of money for health care without social sensitivity by the government, since the little money which is used for health is allocated to administrative activities without an adequate balance [9]. Quality and its adequate monitoring requires the health services to be passionate about what they are working on a day-to-day basis, together with the proper co-responsibility of both sides of the government of the population [10]. It is important to emphasize this information of the health system and its goal to which it wants to arrive [11]. "The quality of health care does not reside in a particular person, device or unit, but in the interactions between all the components of the system."

The tenth essential public health function is: Research, development and implementation of innovative solutions in public health:

- Relevant and useful research to inform the action of the decision makers in matters related to health.

- Applied research to drive changes in public health practices.

-Development of own investigation of the sanitary authorities in its different levels.

-Inter-institutional collaboration to carry out studies that support decision-making in health.

-The establishment of alliances with research centers and academic institutions to make timely studies that support decision-making of health authority at all levels and the broadest scope of its field of action ([3] cited by [1]).

The Mexican health system needs relevant information to be able to create new public policies that help to create a stable and honest research system. WHO contributes to the idea that investment in applied research supports universal health coverage by adapting to the type of country implementing it from a prevention approach to a better functioning health system [13]. At present, the development of research by health authorities must achieve an adequate quality for the population, which is increasingly interested in intervening in an interdisciplinary way with the institutions. To create social awareness and knowledge, it is important that when an investigator has important results within reach after having done the relevant process to avoid bias, make known that information as it helps to strengthen and identify potential problems in population health [14]. It is necessary to create a stable and strong knowledge that can serve any adverse health situation that may affect the population, so it is important that investment by the country for this important sector is enriched and supports research through interinstitutional collaboration and the establishment of agreements as well as alliances with centers that develop this type of studies.

Finally, the eleventh essential public health function refers to the Reduction of emergencies and disasters in health:

- Have a health system that is prepared and has the human and material resources to prevent and face timely the damage to health caused by natural disasters.

-Plan and operate emergency prevention, preparedness, response and early rehabilitation actions related to urgencies.

- Multiple approach to the damages and the etiology of each and every one of the emergencies or possible disasters in the reality of the country.

-Participation of the National Health System and intersectoral collaboration in reducing the impact of emergencies and health disasters ([3] cited by [1]).

3. Discussion

In Mexico, having a knowledge of a health system that is prepared to timely prevent damages from natural disasters and adequate early rehabilitation helps to have a chain reaction [12]. According to Newton's third law "Every action corresponds to a reaction" it is interesting to apply it to the fact that if the country has sufficient resources and first knows the place where it is located and what kind of risks can occur, chain action that could immediately affect the health system can be stopped [12]. What is primordial is the knowledge of the terrain in which we grow, in which we live, in which we were born. Knowledge is essential to create bridges with the different states of the republic, planning prevention, preparedness and response operations means that there is adequate participation of the population and bureaucratic sectors that often because they do not know the area in which they live , create measures that are not adapted to the health needs of our country.

While essential functions could mean a number of indicators in the population health of any country here the fundamental question is whether the essential functions of public health are fulfilled in Mexico? What is the level of health of the Mexican population dependent on the performance of public health functions? In order to understand this, it would be necessary to see if these functions are evaluated by the health units, and How are the indicators manifested in health in our country?

Finally, other aspects to consider are social participation and empowerment of citizens in health, which is closely related to "shared responsibility in public health", defined as community participation in the preservation or improvement of their state of health together with the authorities assuming a mutual commitment [10], which is one of the fundamental axes to promote if it is intended to achieve significant changes in public health.

The commitment and responsibility to keep a population healthy should not be just the government, because it is a unilateral effort that will not have the expected effects if the population is not aware of their health situation and that they themselves must start from the nucleus of the community, first identifying the risk factors, those that belong to the environment that surrounds them, those that come from themselves. Once the risk factors have been identified, the next step to be taken by the government and residents is to generate habits and healthy behaviors, hygiene and quality of life. This is supported by values such as honesty, knowledge, the passion of those involved and the social sensitivity of both components of the binomial. This is also related to the role of research, development and implementation of innovative solutions in public health, so that through this new approach of shared responsibility, solutions to public health problems that have not been for a long time resolved.

Another of the essential functions of public health that is analyzed in this writing is referring to the development of policies, plans and management capacity. "Health Management is defined as the application of the administration of goods and services, through participatory strategic planning that generates a continuous improvement in the well-being of the human being that translates into health" [1], which is a primordial aspect, since it refers to applying the knowledge for the generation of public policies with the objective of improving the quality of health services in the population. The above-mentioned values-attributes, mainly honesty and knowledge on the part of public policy managers are fundamental for better public health conditions in our country, this also means that those who formulate public policies and who are immersed in promoting health, have to be honest and competent, feel passion for their work and have social sensitivity.

4. Conclusions

The quality of the work based on values-attributes, honesty, knowledge, passion and social sensitivity is deficient derived from antivalues-corruption, so in addition, the execution of the essential functions of public health in our country is limited, so quality of poor health care. All this is associated with actions that denote the non-consideration of the curriculum vitae to aspire for jobs, which have an economic cost and denote control where corruption is present.

The quality of care could be improved simply by implementing the values-attributes that denote transcendence for health decision-making, by way of reflection. Do you know the resume of the person who serves you in the consultation, or who makes your laboratory exams? How do I enter the health system of our country? Are honesty, knowledge, passion and social sensitivity values-attributes that stand out in the quality of health care? We cordially invite the reader of this article to express his own conclusion regarding the quality of care and to question whether the implementation of the essential functions of public health effectively responds to the needs of society where we all demand improvement in the individual and collective health in our country.

Acknowledgements

The authors are deeply grateful to PROMEP for the support for the publication of this article, since it represents a stimulus to generate knowledge and its transference with a scientific character.

Declaration of Conflict of Interest

The authors declare that there is no conflict of interest for the publication of this article.

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